1. Field of the Invention
The present invention relates to a surgical aid and more particularly relates to a device for stretching or expanding skin for the purpose of facilitating a difficult closure of large skin wounds which are routinely encountered in general surgical fields, e.g., trauma and more specialized fields such as general and reconstructive plastic surgery, orthopedic, podiatric, and chronic wounds.
2. Brief Description of the Related Art
As is traditionally known in the surgical field, when surgeons are faced with medium sized defects, the margins of which are not easily approximated, the surgeons will undercut the wound edges a few centimeters to in order to mobilize tissue for a relaxed closure. If the surgeon is faced with even larger defects which would be even more difficult to close, the surgeon may perform a wound covering skin graft by bringing in a completely detached portion of extra tissue from a distant site on the body. In this situation, the surgeon may also construct a cover for the wound in the form of a skin flap by elevating redundant, contiguous, near-by tissue and then partially detaching it, moving it, and seating it into the defect.
The ability to stretch or expand adjacent skin to generate extra tissue for wound cover is due to the fact that skin, when intermittently tensioned, will significantly elongate beyond its intrinsic limits, without damage to the physical integrity of the skin. This results because the collagen fibers, which form skin, have the ability to uncoil, align, and compact more closely together in response to a sustained, applied load. The collagen fibers thus have no power of retraction. When skin which has been stretched is anchored to a fixed point, the natural elasticity imparted by the relatively weak elastic fibers, is unable to revert the skin back to its original state.
There are three general purposes in which a skin tensioning device may be used. First, a skin tensioning device may be used to generate additional tissue for the sutured closure of surgically created skin defects in either their pre-operative or intra-operative state. Second, the device may be used to traction assist the natural contraction and non-sutured closure of open skin defects which may have been surgically operated or may have been the result of trauma or pressure. Third, the device may act as an adjustable retention suture bolster in the post-operative phase of general surgical procedures, including replacement and reconstructive surgery (e.g., hip or knee replacement surgery).
One conventional skin tensioning device of the prior art is found in U.S. Pat. No. 5,127,412 to Cosmetto et al. and is hereby incorporated by reference in its entirety. FIG. 1 shows a prior art device commercially available from the assignee hereof and is marketed under the trade name "STAR". As shown in FIG. 1, the tension set 10 includes an anchor member 12 having a body portion 14 and a pair of suture guide slots 16 formed in a bottom thereof. A winder 18 is coupled by sutures to anchor 12. Winder 18 has a body portion 20 with suture guide slots 24 formed in the bottom not unlike anchor 12. Winder 18 also includes a central reel 26 with suture anchoring guide slots 28, a ratchet 30 at one end. A driver 32 is complementary to ratchet 30 and is used to ratchet reel 26. A typical wound is sutured using tension set 10 by passing a suture 36 through one of suture guide slots 16 in body 14 of anchor member 12. Suture 36 then enters the full thickness of the skin, exits through the subcutaneous tissue and extends across the wound. It enters the subcutaneous tissue of the opposite side of the wound and is passed up and through the full thickness of the skin and then across the surface of the skin parallel to the length of the wound. Suture 36 then passes through one of suture guide slots 24 in winder body 20 and then through one of suture guide slots 28 of central reel 26. Suture 36 is then passed across and through the other of suture guide slots 28 of central reel 26 and then through the other of suture guide slots 24 in winder body 20. Suture 36 then re-enters the skin and passes the full thickness of the skin exiting through the subcutaneous tissue of the same side as winder 18 and then extends back across to the opposite side of the wound where it re-enters the subcutaneous tissue and passes up through the skin into and through the other of guide slots 16 of anchor member 12. It is then tied to the free end of suture 36 at the starting point. The externalized suture 36 on the side of the wound opposite winder 18 and reel 26 is grasped by the comb-like sidewall of anchor member 12. Thereafter, winder 18 is ratcheted by the surgeon to apply tension through sutures 36 in parallel manner across the wound, thereby stretching the skin. This skin tensioning process may take place before or during the operation while the skin extends under the gentle tension applied by tension set 10.
While the skin tensioning device of U.S. Pat, No. 5,127,412 and other prior art devices have particular utility as a skin tensioning device, the process of using this device involves a multiplicity of steps during a surgical procedure. For example, suture 36 had to be loaded into both the winder body 20 and the central reel 26. More specifically, suture 36 was passed through one of suture guide slots 24 in winder body 20 and then also had to be passed through one of suture guide slots 28 formed in central reel 26 before being looped across central reel 26 and passed through the other of suture guide slots 28 formed in central reel 26. Suture 36 was then passed through the other of guide slots 24 in winder body 20 before extending across the wound. After having loaded suture 36 in both central reel 26 and winder body 20, central reel 26 is inserted into winder body 20 to permit the ratcheting action to wind suture 36, and thereby stretch the skin. Consequently, this prior art device required the surgeon or other user to carefully couple suture 36 to central reel 26 by threading suture 36 through the pair of suture guide slots 28 in central reel 26. These steps add complexity and time to the skin tensioning process using this prior art device. In addition, because suture 36 is coupled to reel 26 through the pair of suture guide slots 28, any movement of reel 26 will accordingly cause suture 36 to be displaced. For instance, if the operator wishes to remove or reposition reel 26 in relation to winder body 20, suture 36 will also be unnecessarily pulled in this direction.
Accordingly, it would be desirable to provide a skin tensioning device which offers the utility of the prior art device; however, reduces the complexity of use and generally reduces the number of steps required by the skin tensioning process using such a device.